Provider Demographics
NPI:1457729790
Name:MARTINEZ-TORO, JORGE A (CP 796)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:A
Last Name:MARTINEZ-TORO
Suffix:
Gender:M
Credentials:CP 796
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CALLE 5
Mailing Address - Street 2:JARDINES DEL CARIBE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-4466
Mailing Address - Country:US
Mailing Address - Phone:787-326-0676
Mailing Address - Fax:
Practice Address - Street 1:2162 BLVD LUIS A FERRE URB VILLA GRILLASCA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0722
Practice Address - Country:US
Practice Address - Phone:787-840-1110
Practice Address - Fax:787-840-0003
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR796101YA0400X
PR6235103TA0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)